A Case of Lithium Toxicity within Normal Creatinine Range during Lithium Maintenance Treatment / 신경정신의학

Lithium is a widely used drug for treatment of bipolar disorder. Because of its narrow therapeutic range and renal toxicity, most clinical guidelines recommend regular monitoring of serum lithium level and kidney function for patients taking lithium. We report on a case of a 20 year-old man with occurrence of lithium toxicity after more than one year of lithium maintenance therapy with daily lithium intake of 900 mg. His serum creatinine level was within normal range at admission and elevated compared to his baseline, but still within normal range when lithium toxicity occurred. Acute kidney injury associated with dehydration, analgesics, and nephrotoxic effect of lithium might be a risk factor of lithium toxicity. This case showed the importance of thorough monitoring of serum creatinine level change even if its elevated result is within normal range in observing renal function of patients treated with lithium.

A case report of a bipolar disorder patient with severe lithium poisoning possibly induced by interaction between risperidone, telmisartan, fluvoxamine and lithium.

We describe a case of severe lithium poisoning possibly induced by multiple drug interaction. A 45-year-old man with bipolar disorder was admitted with altered behavior and mental status. He was maintained on lithium for 20 years. Nine months ago, lithium dose was increased and risperidone was added. Telmisartan was prescribed around 25 days ago and he had mild tremor since then. Two days ago, fluvoxamine was initiated and he developed restlessness, agitation, insomnia and confusion after one dose. On admission, fluvoxamine, lithium, telmisartan and risperidone were discontinued. Abnormal findings were temporary ST depression, hyponatremia and high creatine kinase. He had fever since day 2 and was covered for meningoencephalitis and neuroleptic malignant syndrome. On the next day, he was comatose and treated for septic shock. On day 7, result of serum lithium taken on day 3 revealed severe toxicity (3.2 mEq/L). The lithium level was normalized after hemodialysis. He subsequently regained full Glasgow Coma Scale score and his toxicity completely resolved on day 16. Interactions of risperidone and telmisartan with lithium possibly precipitated the lithium toxicity. However, the onset of the toxicity suggested fluvoxamine as the major cause of poisoning. Clinicians should be aware of these potential drug interactions.

A Case of Lithium Toxicity in a Patient Treated with Maintenance Dose of Lithium / 대한정신약물학회지

Lithium is widely used in the treatment of various psychiatric disorders, including bipolar disorder. Lithium has been known to have a narrow therapeutic range inducing severe toxic effects with overdose. Many clinical guidelines recommended clinicians to check serum levels and renal panels regularly during lithium administration. In this case report, we report a case of 60 years old man with severe lithium toxicity, who was taking daily dose of lithium 900 mg through an year. The serum lithium level checked 4 months before admission was 0.4 mEq/L. He restarted his habitual drinking a few months before admission, and soon after acute confusional symptoms were occurred to bring him to emergency room of the Dongguk University International Hospital. During hospitalization the highest serum lithium level was found to be 3.55 mEq/L. He was treated with hemodialysis and recovered without any prominent sequela. Acute renal failure associated with dehydration, alcohol drinking, and nephrotoxic effects by lithium were thought to be risk factors of lithium toxicity.

Complete Heart Block due to Lithium Toxicity / 대한정신약물학회지

Lithium treatment has been associated with a wide range of cardiac complications. We observed a 53-year-old female patient who presented with complete heart block due to lithium toxicity. The patient had been diagnosed as schizoaffective disorder and had been taking a stable dose of lithium, 1,500 mg/day since January 2007. Recently, she begun a strict diet and experienced muscle weakness and lethargy a few days later. While receiving fluid therapy, she lost her consciousness and was transferred to an emergency medical center. An electrocardiogram revealed that she had complete heart block, so a temporary pacemaker was inserted immediately. After 4 days of intensive care, her heartbeat recovered spontaneously and the temporary pacemaker was removed. On the 11th day, she had sufficiently recovered and could ambulate by herself. Lithium levels were measured at 5.22 mEq/L and 0.66 mEq/L on the 1st and 4th day of treatment, respectively. This case illustrates the importance of educating patients and their relatives about the possible lithium toxicity caused by a strict diet.

Complete Heart Block due to Lithium Toxicity / 대한정신약물학회지

Lithium treatment has been associated with a wide range of cardiac complications. We observed a 53-year-old female patient who presented with complete heart block due to lithium toxicity. The patient had been diagnosed as schizoaffective disorder and had been taking a stable dose of lithium, 1,500 mg/day since January 2007. Recently, she begun a strict diet and experienced muscle weakness and lethargy a few days later. While receiving fluid therapy, she lost her consciousness and was transferred to an emergency medical center. An electrocardiogram revealed that she had complete heart block, so a temporary pacemaker was inserted immediately. After 4 days of intensive care, her heartbeat recovered spontaneously and the temporary pacemaker was removed. On the 11th day, she had sufficiently recovered and could ambulate by herself. Lithium levels were measured at 5.22 mEq/L and 0.66 mEq/L on the 1st and 4th day of treatment, respectively. This case illustrates the importance of educating patients and their relatives about the possible lithium toxicity caused by a strict diet.